title: Belgian general practitioners' perspectives on the use of palliative sedation in end-of-life home care: a qualitative study.
abstract: BACKGROUND
  Palliative sedation (PS) is a far-reaching palliative measure with a life-shortening potential. Guidelines provide only for a restricted use of PS and as a last resort.
  
  
  OBJECTIVE
  To explore PS practice in end-of-life (EoL) home care.
  
  
  METHODS
  This was a qualitative analysis of semi-structured interviews with 52 general practitioners (GPs) of Flanders, Belgium.
  
  
  RESULTS
  Apart from GPs who adhere to the existing prerequisites for PS, opinions diverge among GPs on the indication area for PS and on possible life-shortening intentions. The key to GPs' broadened view on "which suffering merits PS" is the fragile context of EoL home care, and the key to GPs' possible life-shortening intentions is their need to facilitate the dying process, when trying or lengthy. When honoring a terminally ill patient's request for euthanasia, several GPs prefer slow euthanasia using PS to a lethal injection.
  
  
  CONCLUSIONS
  PS home practice deviates from the PS guidelines' recommendations. In addition to the GPs' shortage of knowledge, the guidelines' recommendations do not always meet the particular needs of EoL home care. If one consideration of EoL home care is to respect a patient's wish to die at home, then the pre-emptive use of PS to avoid a futile transfer to the hospital in the case of an undesirable turn of events deserves more attention in the PS debate.
authors.affiliation: Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium. Electronic address: maria.sercu@skynet.be.
authors.forename: Maria
authors.initials: M
authors.lastname: Sercu
authors.affiliation: Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Pype
authors.affiliation: Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium.
authors.forename: Thierry
authors.initials: T
authors.lastname: Christiaens
authors.affiliation: Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium.
authors.forename: Anselme
authors.initials: A
authors.lastname: Derese
authors.affiliation: Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium.
authors.forename: Myriam
authors.initials: M
authors.lastname: Deveugele
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001530:Belgium; D005260:Female; D058005:General Practitioners / Q000523:psychology*; D006699:Home Care Services; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D013727:Terminal Care / Q000379:methods*
chemical_list: D006993:Hypnotics and Sedatives
keywords: General practitioner; continuous deep sedation; decision making; end-of-life care; home care; practice guideline; sedation; sedation to unconsciousness; terminal care